Predictors of outcomes after rotator cuff repair-A meta-analysis

Jayaprakash Raman; David Walton; Joy C MacDermid; George S Athwal

doi:10.1016/j.jht.2016.11.002

Predictors of outcomes after rotator cuff repair-A meta-analysis

J Hand Ther. 2017 Jul-Sep;30(3):276-292. doi: 10.1016/j.jht.2016.11.002. Epub 2017 Feb 23.

Authors

Jayaprakash Raman¹, David Walton², Joy C MacDermid³, George S Athwal⁴

Affiliations

¹ School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada. Electronic address: jpraman@gmail.com.
² School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.
³ School of Physical Therapy, Western University, London, Ontario, Canada; Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada.
⁴ Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada.

PMID: 28237073
DOI: 10.1016/j.jht.2016.11.002

Abstract

Study design: Systematic review.

Introduction: Clinical outcomes associated with rotator cuff repair (RCR) are generally favorable, but no study has attempted to establish a set of predictors that affect outcomes.

Purpose of study: This study aims to statistically analyze articles and establish a set of predictors that affect outcomes after RCR.

Methods: An electronic literature search of multiple databases was conducted to identify studies that addressed prognosis after RCR. Quality ratings were conducted with a prognostic study evaluation tool. Summary data for predictors and outcomes were extracted, entered in comprehensive meta-analysis software, transformed where necessary, and pooled to allow for estimation of odds ratio for each predictor.

Results: From 18 studies, 3 were high quality, 7 were moderate and 8 were low-quality studies. Fatty infiltration had a significant negative effect (OR = 9.3), whereas larger tear size, lower preoperative muscle strength (OR = 4.0), multiple tendon involvement (OR = 6.0), diabetes, and worker's compensation status (OR = 8.7) had a moderate negative effect on outcomes after RCR. Older age had a modest negative effect on cuff integrity at follow-up (OR = 2.8), but no significant effect on function. In addition, a history of trauma, smoking, and duration of symptoms before surgery had no significant effect on outcomes.

Discussion: Injury to the cuff (body structure), physical impairment, personal factors and social factors affects outcomes; although the importance of predictors varies between anatomic and functional outcomes.

Conclusions: A multifactorial biopsychosocial prognosis should be considered in management.

Level of evidence: Level 2.

Keywords: Meta-analysis; Prognosis; Rotator cuff repair; Rotator cuff tear.